Grubbs P E, Marini C, Toporoff B, Nathan I, Basu S, Acinapura A J, Cunningham J N
Dept. of Surgery, Maimonides Medical Center, Brooklyn, NY 11219.
Surgery. 1988 Aug;104(2):216-23.
Paraplegia after thoracoabdominal aneurysm repair can occur in 3% to 40% of patients. This study investigated the efficacy of cerebrospinal fluid (CSF) drainage to protect the spinal cord during aortic cross-clamping (AXC) and the interrelationship between drainage, spinal cord perfusion pressure (SCPP), and changes in somatosensory evoked potentials (SEP) in a canine model of spinal cord ischemia. SCPP was defined as the mean distal aortic pressure minus the CSF pressure. In the experimental group, CSF was drained before AXC. SEP changes were quantitated as time to latency increase of 10% (L-10) and time to complete SEP loss. Drainage of CSF had no significant effect on the distal aortic pressure but significantly increased SCPP from 9.4 to 21.8 mm Hg and decreased the incidence of postoperative neurologic injury. Ischemic SEP changes were highly significant predictors of postoperative neurologic injury, occurring more than two times earlier in the paralyzed and paraparetic animals. Dogs without neurologic injury had significantly higher SCPP, delayed L-10 time, and delayed SEP loss.
胸腹主动脉瘤修复术后截瘫的发生率在3%至40%的患者中出现。本研究在脊髓缺血犬模型中，调查了脑脊液（CSF）引流在主动脉交叉钳夹（AXC）期间保护脊髓的效果，以及引流、脊髓灌注压（SCPP）和体感诱发电位（SEP）变化之间的相互关系。SCPP定义为远端主动脉平均压减去脑脊液压力。在实验组中，在AXC之前引流脑脊液。SEP变化定量为潜伏期增加10%（L-10）的时间和SEP完全消失的时间。脑脊液引流对远端主动脉压力无显著影响，但使SCPP从9.4毫米汞柱显著增加到21.8毫米汞柱，并降低了术后神经损伤的发生率。缺血性SEP变化是术后神经损伤的高度显著预测指标，在瘫痪和截瘫动物中出现的时间比正常动物早两倍以上。没有神经损伤的犬SCPP显著更高，L-10时间延迟，SEP消失延迟。
